MEDICARE: MR. GABRIEL EZECHUKWU NDUKWU DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT7279	MS
2	225100000X	Physical Therapist	040194	NY
3	2251G0304X	Geriatric Physical Therapist	PT44171	FL

General Provider Information

NPI Number	:	1083340509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GABRIEL EZECHUKWU NDUKWU DPT

Provider Business Mailing Address
First Line	:	1841 LONG IRON DR APT 807
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-6602
Country	:	US
Telephone Number	:	228-365-8476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 LONG IRON DR APT 807
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-6602
Country	:	US
Telephone Number	:	228-365-8476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	03/30/2026

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